Botanical Treatment Of Chronic Pelvic Pain: Marijuana

One herb, not available widely (or at least, legally available) for clinical use that has clinically demonstrated significant uterine antispasmodic and analgesic effects is Cannabis indica, more commonly referred to as marijuana. This controversial medicinal plant and recrea-tionally used herb has a long history of use for relief of uterine spasms and dysmenorrhea, considered by the Eclectics to be a “soothing uterine tonic.” In fact, its use is ancient, with references and artifacts of its use found widely in Middle Eastern, Ayurvedic, and Semitic writings, continuing through to its medical use in Europe well into the late nineteenth century for the treatment of a variety of gynecologic and obstetric conditions, not limited to but including dysmenorrhea. A pharmaceutical product from the late nineteenth century, Dysmenine Compound, produced by the Keysall Pharmical Company, Kansas City, MO, contained Cannabis, Cypripedium, Scutellaria, Pulsatilla, Viburnum prunifolium, Caulophyllum, Viburnum opulus, and Capsicum. The compound was indicated for dysmenorrhea, menstrual colic, and cramps. Indeed, this formula is not very different from one that might be prescribed by herbalists today (see sample formulae in the following); however, minus the now illegal cannabis and the ecologically endangered lady’s slipper orchid (Cypripedium). Although it is not possible given the current legal-medical climate surrounding the use of Cannabis to prescribe this herb clinically, it is worthwhile to note its use and possible beneficial effects, as these have likely not escaped those who manage to procure it for self-medication for the treatment of chronic or cyclic pelvic pain. Russo et al., in Women and Cannabis: Medicine, Science, and Sociology, provide substantial evidence of its use. They cite Grinspoon and Bakalar in their 1993 site Marihuana, the forbidden medicine, who discuss numerous case studies of women using cannabis effectively to treat PMS, menstrual cramps, and labor pain, and when used at low doses, without cognitive impairments. They also cite an Australian study of the uses of cannabis for obstetric and gynecologic complaints in which 51% of respondents indicated use for PMS or dysmenorrhea. Discussing this herb’s appropriate use with patients, outside the context of prescribing or condoning its use, is therefore possibly important and appropriate. The mechanisms of action appear to be primarily through anti-inflammatory activities. An interesting approach for inflammation-mediated pelvic pain is the use of the seeds of the hemp plants, which are notably rich in gamma-linolenic acid, in which women with PMS and dysmenorrhea have found to be low. In one study, a daily dose of 150 to 200 mg of over 12 weeks greatly improved PMS related symptoms; this dose could be provided by a 5-mL daily dose of hemp seed oil.